Roentgenray Study In Foreign Body Cases

Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

Roentgenography.--All cases of chest disease should have the benefit

of a roentgenologic study to exclude bronchial foreign body as an

etiological factor. Negative opinions should never be based upon any

plates except the best that the wonderful modern development of the

art and science of roentgenology can produce. In doubtful cases, the

negative opinion should not be conclusive until a roentgenologist of

long experience in chest work, and especially in foreign body cases,

has been called in consultation. Even then there will be an occasional

case calling for diagnostic bronchoscopy. Antero-posterior and lateral

roentgenograms should always be made. In an antero-posterior film a

flat foreign body lying in the lateral body plane might be invisible

in the shadow of the spine, heart, and great vessels; but would be

revealed in the lateral view because of the greater edgewise density

of the intruder and the absence of other confusing shadows.

Fluoroscopic examination will often discover the best angle from which

to make a plate; but foreign bodies casting a very faint shadow on a

plate may be totally invisible on the fluoroscopic screen. The value

of a roentgenogram after the removal of a foreign body cannot be too

strongly emphasized. It is evidence of removal and will exclude the

presence of a second intruder which might have been overlooked in the

first study.

Fluoroscopic study of the swallowing function with barium mixture, or

a barium-filled capsule, will give the location of a nonroentgenopaque

object (such as bone, meat, etc.) in the esophagus. If a flat or

disc-shaped object located in the cervical region is seen to be lying

in the lateral body plane, it will be found to be in the esophagus,

for it assumed that position by passing down flatwise behind the

larynx. If, however, the object is seen to be in the sagittal plane it

must lie in the trachea. This position was necessary for it to pass

through the glottic chink, and can be maintained because of the

yielding of the posterior membranous wall of the trachea.